INTERNATIONAL CONFERENCE

ON NUTRITION

Final Report of the ConferenceRome, December 1992

I TERNATI NAL NFEN TRIFI

Rome, December 1992

inaI e ort of rem

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

WORLD HEALTH ORGANIZATION

Reprinted 1996

The designations employed and the presentation of material in thispublication do not imply the expression of any opinion whatsoeveron the part of the Food and Agriculture Organization of the UnitedNations or of the World Health Organization concerning the legalstatus of any country, territory, city or area or of its authorities, orconcerning the deiimitation of its frontiers or boundaries.

All rights reserved. No part of this publication may be reproduced, stored in aretrieval system or transmitted in any form or by any means, electronic,mechanical, photocopying or otherwise, without the prior permission of thecopyright owner. Applications for such permission, with a statement of thepurpose and extent or the reproduction, should be addressed to the Director,Publications Division, Food and Agriculture Organization of the United Nations,Viale delle Terme di Caracalla, 00100 Rome, Italy.

0 FAO and WHO 1992

FIN i REPORT OF TILEINTERNATIONAL CONF'ERENCE ON NUTRITION

CONTENTS

Page

PART I - PROCEEDINGS

Inaugural Ceremony 1

Opening of the Conference 1

PART II- WORLD DECLARATION AND PLANOF ACTION FOR NUTRITION

WORLD DECLARATION ON NUTRITION 9

PLAN OF ACTION FOR NUTRITION 15

Introduction 15

Major Policy Guidelines 17Intersectoral Issues 22Strategies and Actions 24Responsibility for Action 49Recommendations for the Follow-upof the Conference 52

PART Ill - PARTICIPATING COUNTRIES ANDORGANIZATIONS

PART I. PROCEEDINGS

INAUG L CEREMONY

Mr Ibrahim Adam (Ghana), Chairman of the Preparatory Committeemeetings for the International Conference on Nutrition (ICN), welcomed delegatesto this historic gathering of governments, international and non-governmentalorganizations, noting that it was the first time such a group had convened to worktogether for a world free from hunger and malnutrition. The Conference vieweda film, "Nutrition: The Global Challenge", after which the Director-General ofFAO welcomed His Holiness, Pope John Paul II, who gave the inaugural address.

The Pope paid tribute to WHO and FAO for combining their efforts inorganizing the International Conference on Nutrition and sharing theiraccumulated experiences in the service of humanity. He noted that the actions ofthe Conference are governed by the quest for a world in which each individualcan enjoy a standard of living that befits human dignity. He expressed hope thatthe Conference would bring renewed and vigorous action to place food and healthhigh on the international agenda.

The Pope said that access to resources and technology as well as educationand health services must be guaranteed. He observed that while the inalienableright to food has been asserted, we must ensure that this right is applied. Often,populations are placed at nutritional risk because of lack of peace and justice andthe damage to the environment. His Holiness said that wars and civil conflictsshould not be allowed to condemn defenceless civilians to die of hunger forselfish or partisan reasons.

His Holiness noted that the ICN Declaration and Plan of Action place thefamily unit at the centre of programmes for education and training. Hehighlighted the right of the couple to decide on the spacing of its offspring.While it is not the Church's role to propose technical solutions, it will fullysupport the strengthening of international solidarity and the promotion of justice.In this spirit, he called on the Conference to work for a world in which no oneis denied his or her daily bread or health care. He offered blessings on theConference participants and all peoples of the earth.

OPENING OF THE CONFERENCE

H.E. Ibrahim Adam, opened the Conference, welcomed delegates to theICN and called for nominations for the Chairperson of the Conference. Delegatesfrom 159 countries and the European Economic Community, including137 ministers, representatives from 144 non-governmental organizations (NG0s),

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11 intergovernmental organizations and 16 UN organizations attended theConference. The total number of registered participants was 1 387.

Agenda Item 1: Conference Procedural and Organizational Matters

The Nominations Committee for the Conference Bureaux was comprisedof Mr R. de Pourtalès, Switzerland (Chair), Angola, Austria, Cameroon, Cyprus, -El Salvador, Estonia, Germany, Haiti, Honduras, Iraq, Kenya, Myanmar,Pakistan, Saudi Arabia, Thailand, United Kingdom and the United States ofAmerica. Following the report of this Committee, the following officers of theConference were elected.

Madame Simone Veil of France was elected Chairperson of theConference. Mr H.E. Chowdhury Kamal Ibne Yusuf (Bangladesh), Madame ChenChunming (People's Republic of China), Madame Maria Eletta Martini (Italy),Dr Eiichi Nakamura (Japan), H.E. Adel Cortas (Lebanon), H.E. Dr ErnestoSalmerón Bermúdez (Nicaragua) were elected Vice-chairpersons of the

Conference. Dr Guy Nantel (Canada) and Dr M'Barek Essatara (Morocco) wereelected as general Rapporteurs.

The Conference adopted the provisional agenda and timetable as presentedin document ICN/92/INF/2. The Rules of Procedure and the Organization ofWork were adopted as contained in documents ICN/92/3 and

PREPCOM2/ICN/92/FINAL REPORT.

Mr Edouard Saouma, Director-General of FAO welcomed the delegatesand expressed his pleasure and honour in hosting the first world conference onnutrition together with WHO. He recalled that the mandate for the Conferencecame from the entire United Nations and welcomed the participation of non-governmental organizations in the ICN.

Mr Saouma emphasized that humans' most fundamental need and right isaccess to sufficient supplies of nutritionally adequate food. He deeply regrettedthe explosion of food crises due to natural disasters, war and the collapse ofeconomic and political systems and stated that we are duty-bound to intervenewhen populations face famine.

It is always the poor who are at risk of malnutrition, Mr Saoumaobserved. The ICN intends to awaken the sense of individual and collectiveresponsibility and commitment to meeting the nutritional challenge inherent infighting poverty.

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Nutrition is one of the foundations of human society and human solidarity.Mr Saouma called for a constructive dialogue with the food industry, consumers,health professionals, as well as government representatives and internationalorganizations, urging everyone to seize this extraordinary opportunity to allow allpeople to realize their full human potential.

Dr Hiroshi Nakajima, Director-General of the World Health Organization,called for a planetary pact to attack the problems of hunger, malnutrition and diet-related diseases. This conference, he noted, was the first of its kind where healthand agriculture have joined together to address the nutritional security of allpeoples, and as such, places nutrition in its rightful place in development policy.

Full participation of all multilateral, bilateral, and non-governmentalorganizations to support activities at the country level will be essential for successin alleviating and eventually eliminating nutritional problems and promotinguniversal health and nutritional well-being.

WHO pledged to work with countries in implementing their national plansof action along the lines of the World Declaration and Plan of Action forNutrition. WHO will focus, in particular, its special efforts and resources oncountries and populations in greatest need and on vulnerable groups worldwide;it will build on local experience and local initiatives.

Dr Nakajima emphasized that major improvements in nutritional well-being are within sight; our ultimate goal is the health and nutritional well-beingfor all, for a better, longer, and more productive life.

Agenda Item 2: General Discussion of the World Declaration and Plan of Actionfor Nutrition

The Conference met in Plenary on 5 December and from 7-9 Decemberfor general discussions on the World Declaration and Plan of Action forNutrition. In Conference Plenary sessions 163 statements were made by headsof delegations from countries, non-governmental organizations, intergovernmentalorganizations and UN agencies.

Delegates described the food and nutrition situations in their countries.Undemutrition remains the dominant nutritional problem, but over the long termthere has been a gradual reduction in the most severe forms of protein-energymalnutrition (PEM) and some micronutrient deficiencies. However, in areas

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affected by food shortages, and particularly in Africa, severe PEM andmicronutrient deficiencies are worsening or reappearing. At the same time, diet-related non-communicable diseases are increasing in many developing countries.

Delegates described the impact of social and economic conditions on foodsecurity and nutritional status, underlining the need for poverty alleviation andincome generation; for assuring continued access to good quality and safe foodsat affordable prices; for improving women's social and economic status; forproviding health services and education, particularly instruction in child care,hygiene and nutrition; and for balancing population growth with availableresources.

Delegates pointed out that slow economic progress, debt burdens andstructural adjustment are major obstacles to rapid progress in alleviating thehunger and malnutrition prob/ems of many developing countries. Implementingnational plans of action to improve nutrition under these conditions will be amajor challenge and many countries will require assistance.

Country statements emphasized that current world trade practices andpolicies could be detrimental to the economies of developing countries. Hope wasexpressed for a successful outcome to the GÄrIT Uruguay Round along withconcern about the consequences.

Delegates emphasized that peaceful resolution of conflicts, social stabilityand democracy are prerequisites to the improvement of nutritional status.Situations of conflict exacerbate the need for emergency food aid by accentuatingpoverty, displacing persons, and bringing about malnutrition.

Country delegations and NGOs recognized the need for cooperation andcollaboration at the local, national, regional and international levels. In

particular, international solidarity was highlighted as a key element for asuccessful follow-up to the ICN. It was recognized that some countries willrequire technical assistance in developing their national strategies. In order toassure measurable progress, national plans of action will need to define specifictargets and quantifiable goals. The plans of action should adopt a multisectorialand multidisciplinary approach in defining coherent and realistic strategies.Delegates insisted on the importance of integrating nutritional concerns withinnational development plans to assure respect for human dignity.

The importance of monitoring and evaluation was emphasized andsuggestions for an evaluation process on the implementation on the ICN Plan ofAction were made. Delegations called for effective coordination between

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international organizations in implementing the ICN World Declaration and Planof Action for Nutrition, drawing attention to the role of the ACC/SCN infacilitating these efforts. Throughout the Conference, delegations expressedstrong support for the Declaration and Plan of Action, and committed themselvesto the development of their national plans of action. Indeed, the ICN processitself was reported to have stimulated the development of national plans.

Agenda Item 3: Consideration of Draft Texts of the World Declaration and Planof Action for Nutrition

Mr H.E. Ibrahim Adam from Ghana was elected Chairman of theCommission of the Whole to review the draft texts. The Vice-Chairpersonselected were: Ing. Fernando Fuentes Mohr (Guatemala), Dr Peter Biacs(Hungary), Ms M.L.A.C. van den Assum (Netherlands) and Mr S.E. AssadMustafa (Syria). The Drafting Committee to the Commission was comprised ofIndonesia (Professor F.G. Winarno - Chair), Algeria, Austria, Czechoslovalda,Egypt, Germany, Islamic Republic of Iran, Nigeria, Norway, Panama,Philippines, Uruguay, and the United States of America.

The Commission met from 7 to 10 December 1992 to consider the WorldDeclaration and Plan of Action for Nutrition. The Drafting Committeeconsidered suggested modifications and prepared a revised Declaration and Planof Action which was adopted by the Commission and submitted to the Plenary forfinal adoption.

Agenda Item 4: Adoption of the World Declaration and Plan of Action forNutrition

The Chairman of the Commission of the Whole presented the WorldDeclaration and Plan of Action for Nutrition as revised by the Commission to the11 December 1992 Plenary Session. The World Declaration and the Plan ofAction for Nutrition, following clarifications and minor amendments to the draft,were adopted unanimously. These are included as Part II of this report.

In adopting the World Declaration on Nutrition, the Mexican delegationexpressed its support for the World Declaration. However, with regard toparagraph 9 of the World Declaration the representative from Mexico calledattention to the UN Resolution 46/182 of December 1991 and pointed out itsapplicability to this paragraph.

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Representatives of each of the Regional Groups (the United States ofAmerica for North America, Venezuela for Latin America, Iran for the NearEast, Ghana for Africa, Bangladesh for Asia, Austria for Europe, and Australiafor the Western Pacific) endorsed the ICN World Declaration and Plan of Actionfor Nutrition. They called for full and effective follow-up of the Plan of Actionby all concerned, and stressed the willingness of their countries to work togetherto meet the challenges set by the World Declaration and Plan of Action forNutrition.

Following adoption of the Provisional Report of the Conference, theConference was adjourned.

Tu - WORLDDECLÁÀTION IPLOF ACTION FOR RITION

9

WORLD DECL 1 TION ON . ITION

We, the Ministers and the Plenipotentiaries representing 159 states and theEuropean Economic Community at the International Conference on Nutrition(Rome, December 1992), declare our determination to eliminate hunger and toreduce all forms of malnutrition. Hunger and malnutrition are unacceptable in aworld that has both the lcnowledge and the resources to end this humancatastrophe. We recognize that access to nutritionally adequate and safe food isa right of each individual. We recognize that globally there is enough food forall and that inequitable access is the main problem. Bearing in mind the right toan adequate standard of living, including food, contained in the UniversalDeclaration of Human Rights, we pledge to act in solidarity to ensure thatfreedom from hunger becomes a reality. We also declare our firm commitmentto work together to ensure sustained nutritional well-being for all people in apeaceful, just and environmentally safe world.

Despite appreciable worldwide improvements in life expectancy, adultliteracy and nutritional status, we all view with the deepest concern theunacceptable fact that about 780 million people in developing countries20 percent of their combined population still do not have access to enough foodto meet their basic daily needs for nutritional well-being.

We are especially distressed by the high prevalence and increasingnumbers of malnourished children under five years of age in parts of Africa, Asiaand Latin America and the Caribbean. Moreover, more than 2 000 millionpeople, mostly women and children, are deficient in one or more micronutrients:babies continue to be born mentally retarded as a result of iodine deficiency;children go blind and die of vitamin A deficiency; and enormous numbers ofwomen and children are adversely affected by iron deficiency. Hundreds ofmillions of people also suffer from communicable and non-communicable diseasescaused by contaminated food and water. At the same time, chronic non-communicable diseases related to excessive or unbalanced dietary intakes oftenlead to premature deaths in both developed and developing countries.

We call on the United Nations to consider urgently the issue of declaringan International Decade of Food and Nutrition, within existing structures andavailable resources, in order to give additional emphasis to achieving theobjectives of this World Declaration on Nutrition. Such consideration should giveparticular emphasis to the food and nutrition problems of Africa, and of Asia,Latin America and the Caribbean.

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We recognize that poverty and the lack of education, which are often theeffects of underdevelopment, are the primary causes of hunger and undernutrition.There are poor people in most societies who do not have adequate access to food,safe water and sanitation, health services and education, which are the basicrequirements for nutritional well-being.

We commit ourselves to ensuring that development programmes andpolicies lead to a sustainable improvement in human welfare, are mindful of theenvironment and are conducive to better nutrition and health for present andfuture generations. The multifunctional roles of agriculture, especially withregard to food security, nutrition, sustainable agriculture and the conservation ofnatural resources, are of particular importance in this context. We mustimplement at family, household, community, national and international levels,coherent agriculture, animal husbandry, fisheries, food, nutrition, health,education, population, environmental, economic and social policies andprogrammes to achieve and maintain balance between the population and availableresources and between rural and urban areas.

Slow progress in solving nutrition problems reflects the lack of human andfinancial resources, institutional capacity and policy commitment in manycountries needed to assess the nature, magnitude and causes of nutrition problemsand to implement concerted programmes to overcome them. Basic and appliedscientific research, as well as food and nutrition surveillance systems, are neededto more clearly identify the factors that contribute to the problems of malnutritionand the ways and means of eliminating these problems, particularly for women,children and aged persons.

In addition, nutritional well-being is hindered by the continuation of social,economic and gender disparities; of discriminatory practices and laws; of floods,cyclones, drought, desertification and other natural calamities; and of manycountries' inadequate budgetary allocations for agriculture, health, education andother social services.

Wars, occupations, civil disturbances and natural disasters, as well ashuman rights violations and inappropriate socio-economic policies, have resultedin tens of millions of refugees, displaced persons, war-affected non-combatantcivilian populations and migrants, who are among the most nutritionallyvulnerable groups. Resources for rehabilitating and caring for these groups areoften extremely inadequate and nutritional deficiencies are common. Allresponsible parties should cooperate to ensure the safe and timely passage and

distribution of appropriate food and medical supplies to those in need, inaccordance with the Charter of the United Nations.

Changing world conditions and the reduction of international tensions haveimproved the prospects for a peaceful solution of conflicts and have given us anopportunity as never before to redirect our resources increasingly towardsproductive and socially useful purposes to ensure the nutritional well-being of allpeople, especially the poor, deprived and vulnerable.

We recognize that the nutritional well-being of all people is a pre-conditionfor the development of societies and that it should be a key objective of progressin human development. It must be at the centre of our socio-economicdevelopment plans and strategies. Success is dependent on fostering theparticipation of the people and the community and multisectoral actions at alllevels, taking into account their long-term effects. Shorter-term measures toimprove nutritional well-being may need to be initiated or strengthened tocomplement the benefits resulting from longer-term development efforts.

Policies and programmes must be directed towards those most in need.Our priority should be to implement people-focused policies and programmes thatincrease access to and control of resources by the rural and urban poor, raise theirproductive capacity and incomes and strengthen their capacity to care forthemselves. We must support and promote initiatives by people and communitiesand ensure that the poor participate in decisions that affect their lives. We fullyrecognize the importance of the family unit in providing adequate food, nutritionand a proper caring environment to meet the physical, mental, emotional andsocial needs of children and other vulnerable groups, including the elderly. In

circumstances where the family unit can no longer fulfil these responsibilitiesadequately, the community and/or government should offer a support network tothe vulnerable. We, therefore, undertake to strengthen and promote the familyunit as the basic unit of society.

The right of women and adolescent girls to adequate nutrition is crucial.Their health and education must be improved. Women should be given theopportunity to participate in the decision-making process and to have increasedaccess to and control of resources. It is particularly important to provide familyplanning services to both men and women and to provide support for women,especially working women, whether paid or unpaid, throughout pregnancy andbreast-feeding and during the early childhood period. Men should also bemotivated through appropriate education to assume an active role in the promotion

of nutritional well-being.

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Food aid may be used to assist in emergencies, to provide relief torefugees and displaced persons and to support household food security andcommunity and economic development. Countries receiving emergency food aidshould be provided with sufficient resources to enable them to move on from therehabilitation phase to development, so that they will be in a position to cope withfuture emergencies. Care must be taken to avoid creating dependency and to avoidnegative impacts on food habits and on local food production and marketing.Before food aid is reduced or discontinued, Steps should be taken to alert recipientcountries as much in advance as possible so that they can identify alternativesources and implement other approaches. Where appropriate, food aid may bechannelled through NGOs with local and popular participation, in accordance withthe domestic legislation of each country.

We reaffirm our obligations as nations and as an international communityto protect and respect the need for nutritionally adequate food and medicalsupplies for civilian populations situated in zones of conflict. We affirm in thecontext of international humanitarian law that food must not be used as a tool forpolitical pressure. Food aid must not be denied because of political affiliation,geographic location, gender, age, ethnic, tribal or religious identity.

We re-cognize the fact that each government has the prime responsibilityto protect and promote food security and the nutritional well-being of its people,especially the vulnerable groups. However, we also stress that such efforts oflow-income countries should be supported by actions of the internationalcommunity as a whole. Such actions should include an increase in officialdevelopment assistance in order to reach the accepted United Nations target of0.7 percent of the GNP of developed countries as reiterated at the 1992 UnitedNations Conference on Environment and Development.' Also, furtherrenegotiation or alleviation of external debt could contribute in a substantivemanner to the nutritional well-being in medium-income countries as well as inlow-income ones.

"Developed countries reaffirm their commitments to reach the accepted United Nations targetof 0.7 percent of GNP for ODA and, to the extent that they have not yet achieved that target,agree to augment their aid programmes in order to reach that target as soon as possible andto ensure prompt and effective implementation of Agenda 21. Some countries have agreedto reach the target by the year 2000. ... Those countries that have already reached the targetare to be commended and encouraged to continue to contribute to the conunon effort to makeavailable the substantial additional resources that .have to be mobilized. Other developedcountries, in line with their support for reforin efforts in developing countries, agree to maketheir best efforts to increase their level of ODA. ..." (Report of United Nations Conferenceon Environment and Development, Rio de Janeiro, 1992, paragraph 33.13).

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We acknowledge the importance of further liberalization and expansion ofworld trade, which would increase foreign exchange earnings and employment indeveloping countries. Compensatory measures will continue to be needed toprotect adversely affected developing countries and vulnerable groups in medium-and low-income countries from negative effects of structural adjustmentprogrammes.

We reaffirm the objectives for human development, food security,agriculture, rural development, health, nutrition and environment and sustainabledevelopment enunciated in a number of international conferences and documents.'We reiterate our commitment to the nutritional goals of the Fourth United NationsDevelopment Decade and the World Summit for Children.3

As a basis for the Plan of Action for Nutrition and guidance forformulation of national plans of action, including the development of measurablegoals and objectives within time frames, we pledge to make all efforts toeliminate before the end of this decade:

famine and famine-related deaths;a starvation and nutritional deficiency diseases in comtnunities

affected by natural and man-made disasters;iodine and vitamin A deficiencies.

We also pledge to reduce substantially within this decade:

starvation and widespread chronic hunger;undernutrition, especially among children, women and the aged;other important micronutrient deficiencies, including iron;diet-related communicable and non-communicable diseases;

9 social and other impediments to optimal breast-feeding;inadequate sanitation and poor hygiene, including unsafedrinking-water.

3 See Annex I.

2 The World Food Conference, 1974; the Alma Ata Conference on Primary Health Care,1978; the World Conference on Agrarian Reform and Rural Development, 1979; theConvention on the Elimination of All Forms of Discrimination Against Women, 1979,especially articles 12 and 13; the Innocenti Declaration on the Protection, Promotion andSupport of Breastfeeding, 1990; the Montreal Policy Conference on MicronutrientMalnutrition, 1991; the Rio Declaration on Environment and Development, 1992.

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VVe resolve to promote active cooperation among governments,multilateral, bilateral and non-governmental organizations, the private sector,communities and individuals to eliminate progressively the causes that lead to thescandal of hunger and all forms of malnutrition in the midst of abundance.

With a clear appreciation of the intrinsic value of human life and thedignity it commands, we adopt the attached Plan of Action for Nutrition andaffirm our determination to revise or prepare, before the end of 1994, ournational plans of action, including attainable goals and measurable targets, basedon the principles and relevant strategies in the attached Plan of Action forNutrition. We pledge to implement it.

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PL OF ACTION FOR NUT TION

I. INTRODUCTION

1. General

1, Despite considerable progress in recent decades, the world still falls farshort of the goal of adequate food and nutrition for all. Over 780 million people,mainly in Africa, South Asia and Latin America, do not have enough food tomeet their basic daily needs for energy and protein. More than two billion peoplesubsist on diets that lack the essential vitamins and minerals required for normalgrowth and development and for the prevention of premature death and disabilitiessuch as blindness and mental retardation. At the same time hundreds of millionssuffer from diseases caused or exacerbated by excessive or unbalanced dietaryintakes or by the consumption of unsafe food and water.

Eradicating hunger and malnutrition is within the reach of humanldnd.Political will and -well-conceived policies and concerted actions at national andinternational levels can have a dramatic impact on these nutrition problems.Many countries, including some of the poorest, have adopted and taken measuresto strengthen food, nutrition, agriculture, education and health and family welfareprogrammes, which have dramatically reduced hunger and malnutrition. Thecurrent challenge is to build upon and accelerate the progress already made.

This global Plan of Action for Nutrition is designed to provide guidelinesfor governments, acting in partnership with non-governmental organizations(NG0s), the private sector, local communities, families and households andthe international community, including international organizations, multilateralfinancing institutions and bilateral agencies, to achieve the objectives of the WorldDeclaration on Nutrition adopted by the International Conference on Nutrition(ICN). It contains recommendations on policies, programmes and activities thatresulted from an intensive ICN consultative process involving country-levelpreparations of national plans and regional consultations that included countryrepresentatives. It also represents the dra.wing together of a wide range of expertopinion from around the world on the many facets of problems that must bevigorously attacked to achieve proper nutritional status for all on a sustainablebasis. Thus, this Plan of Action builds upon preceding work and represents amajor step in preparing and implementing national nutrition improvement plansin coming years.

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Coherent and effective action at local, national and international levels toachieve nutritional well-being is imperative. However, resources, needs andproblems vary between and within countries and regions of the world. Therefore,the situation in each country and region needs to be assessed in order to setpriorities for formulating specific national and regional plans of action, givingtangible expression to policy-level commitments to improve the nutritional well-being of the population. This should entail considering nutritional impacts ofoverall development plans and of all relevant sectoral development policies andplans. These plans should identify short- and long-term priority areas for action;specify goals, which should be quantified where feasible, to be achieved withinspecified time frames; define the roles of relevant government ministries, localcommunities and private institutions; and, as appropriate, include estimates ofresources that are required. The plans should take into account the goals set forthin the World Declaration on Nutrition and be formulated by governments with theactive participation of academic and local communities, NGOs and the privatesector.

2. Overall objectives

Ensuring continued access by all people to sufficient supplies of safefoods for a nutritionally adequate diet

To achieve satisfactory nutritional status, it is essential to ensure continuedaccess to sufficient supplies of a variety of safe foods at affordable prices and ofsafe drinking-water so that all people, especially the poor and vulnerable groups,can have nutritionally adequate and safe diets. This is an issue of supremeimportance to the many millions of people worldwide who currently suffer frompersistent hunger, malnutrition and micronutrient deficiency diseases and to thoseothers who are at risk of suffering in the future.

Achieving and maintaining health and nutritional well-being of allpeople

Good nutritional status is dependent upon each person having appropriateintakes of macronutrients and micronutrients, combined with adequate health andcare and access to safe drinking-water. Nutritional status also depends on theavailability of sufficient lcnowledge about appropriate diets, ta.king into accountlocal food habits to prevent problems of undernutrition and of diet-related non-communicable diseases. Healthy and properly nourished people are both the

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result of successful development and contributors to it. Nutritional well-beingshould be adopted as a key objective in human development and must be at thecentre of development strategies, plans and priorities.

Achieving environmentally sound and socially sustainable developmentto contribute to improved nutrition and health

7. Development policies and programmes in developed and developingcountries should be sustainable and environmentally sound and lead to improvednutrition and health for both present and future generations. Equally importantis the implementation of agricultural, food, health, family welfare, population,education and development policies that will achieve and maintain a balancedrelationship between population needs and available resources as well as betweenrural and urban areas.

Eliminating families and famine deaths

8. Food emergencies that deteriorate into famines are, in many cases, anindication of a lack of emergency preparedness. While the development ofnational early warning systems and the existence of emergency food reserves canhelp to avoid famines, other factors, such as open political environments at localand central levels and a free press, are crucial.

II. MAJOR POLICY GUIDELINES

Commitment to promoting nutritional well-being

9. Each country should make firm social, economic and politicalcommitments to achieving the objective of promoting the nutritional well-beingof all its people as an integral part of its development policies, plans andprogrammes in the short and long run. At the same time, agriculture, health,education and social welfare, as well as all other relevant sectors and ministries,should consider and, where appropriate, incorporate nutrition objectives into theirplans, programmes and projects. They should also strengthen their capacity tofoster public awareness and social responsiveness as well as to implement andmonitor the progress of these programmes and projects. Equally necessary isensuring coordination through adequate mechanisms to harmonize, promote andmonitor programmes of different ministries, NGOs and the private sector toimprove nutritional status.

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Strengthening agricultural policies

10. Agricultural and overall economic policies should seek to preserve andenhance the productive capacity of agriculture where appropriate, to foster thesustainable growth of agricultural productivity and to create conditions that enablethe agricultural sector to fulfil its multifunctional role as a source of food,employment, income and natural products delivered through sound naturalresource management. Problems of local food shortages should be addressedthrough a judicious combination of production, trade and appropriate levels ofnational, regional and local stocks, with due regard given to the principles of anopen international economic system.

Environmentally sound and sustainable development

11. Assuring access to adequate and safe food supplies, health care, educationand related services can and must be achieved by using sustainable measures thatare environmentally sound. This requires careful planning and utilization ofnatural resources to meet the nutritional and other needs of the growing worldpopulation on a lasting basis without jeopardizing the capacity to meet the needsof future generations. Providing incentives and motivating farmers to adoptsustainable and efficient practices are essential.

Growth with equity: the need for both economic growth and equitablesharing of benefits by all segments of the population

12. Development strategies to reduce poverty and ensure better nutrition forall should be oriented towards achieving economic growth with equity, ensuringsocial justice and protecting and promoting the well-being of all, particularly ofvulnerable groups. Policies that discriminate against people on the basis ofgender, age, ethnic, tribal, religion, political affiliation or other grounds militateagainst social justice. All people in all societies must have equitable access toeconomic resources and opportunities, adequate and safe food, healthy livingconditions and health services, clean water, sanitation and education and relatedset-vices since these are basic requirements for nutritional well-being.

Priority given to the most nutritionally vulnerable groups

13. Infants, young children, pregnant and nursing women, disabled people andthe elderly within poor households are the most nutritionally vulnerable groups.Priority must be given to protecting and promoting their nutritional well-being.Towards this end, their access to adequate care within the household and to

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health, education and other basic social services, such as family planning,maternal and child health (MCH) clinics and social security schemes, should beensured. Special attention must be given to the nutritional, health and educationalneeds of female children and adolescents, which have often been overlooked inthe past. Other groups that may be at risk include some indigenous populations,refugees and displaced persons, and these groups may require particular care andservices to ensure their nutritional well-being.

Focus on Africa

The dramatic deterioration of the nutrition situation in Africa is of seriousconcern and demonstrates the vulnerability of much of the African population.It calls for tangible and sustained support from the international community. Inthis context, support should be given to the proposals for cornbating drought anddesertification in Africa and in other countries facing similar situations adoptedby the United Nations Conference on Environment and Development in 1992.This support must also be given to proposals to promote and protect agricultureand farmers' organizations. The initiative of the OAU, in cooperation with FAO,WHO, UNICEF and other relevant international organizations, to develop aRegional Nutrition Strategy emphasizing the need for the implementation ofnational plans of action is strongly commended and should be concretelysupported.

People's participation

People-focused policies for nutritional improvement must acknowledge thefact that people's own knowledge, practices and creativity are important drivingforces for social change. Local community involvement, including that offamilies and households, is a prerequisite for improving food production andsustaining access to food and for instituting adequate nutrition improvementprogrammes and projects. The importance of the informal sector in theprocessing and distribution of food should be recognized. Special efforts must bemade to ensure the genuine participation of all people, particularly the poor andthe marginalized, in the decisions and actions that are of concern to them in orderto improve self-reliance and assure positive results. All relevant sectors ofgovernment should act in concert with communities and, as appropriate, withNG0s. Community involvement should lie not only in their indicating theirperceived priorities but also in planning, managing and evaluating community-based interventions. Communities must be empowered to achieve sustained

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nutrition development. People's needs should be the focus for all partners indevelopment in the identification of problems and in the planning, implementationand evaluation of intervention.

Focus on women and gender equality

16. Women are inherently entitled to adequate nutrition in their own right asindividuals. They need to constantly balance their reproductive, nurturing,educational and economic roles, which are so important to the health andnutritional well-being of the household and of the entire community. Indeed, theyare the main providers of meals, care and nutrition information in the householdand they have a fundamental role in assuring improved nutritional status for all.Women play a key role in the socio-economic development of rural areas and inmany societies they are also the main producers of food. Special attention shouldbe given to the nutrition of women during pregnancy and lactation. Al] forms ofdiscrimination including detrimental traditional practices against women must beeliminated in accordance with the 1979 Convention on Elimination of All Formsof Discriniination Against Women. In order to promote and ensure meaningfulequality between men and women, women's roles in the community must beunderstood. This will facilitate the sharing of their workload and responsibilitieswith other household members. Equity in the allocation of food between girls andboys must be promoted. Woinen and girls should be afforded equitable access toeconomic opportunities and to educational and training opportunities. Legalmeasures and social practices should guarantee women's equal participation in thedevelopment process by ensuring their access to and right to utilize productiveresources, markets, credit, property and other family resources. Women and menshould have equal access to programmes on family life education, which amongother things would enable couples to plan the spacing of their children. Inaddition to improving education of women, and taking into account the role ofmen in controlling resources and in determining the nutritional status of householdmembers, the nutrition education of men and boys should be enhanced. FAO andWHO have been requested to participate actively in the Fourth World Conferenceon Women to be held in Beijing, the People's Republic of China, in 1995 and toprovide documentation for that conference, in close collaboration with the WorldBank, UNDP, UNICEF and other relevant UN bodies, on the importance ofwomen's and young girls' nutritional well-being and health for their owndevelopment and for the social and economic development of their countries.

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Development of hurnan resources

17. Nutritional well-being is a prerequisite for the achievement of the fullsocial, mental and physical potential of a population so that all people can leadfully productive lives and contribute to the development of the community and thenation with dignity. This implies that improving access to food supplies and tohealth, education and social services contributes to the development of people. Itis also necessary to develop and strengthen capacities for planning, managing andevaluating activities, as well as for providing services, through the training ofadequate numbers of personnel in relevant disciplines, particularly in food andnutritional sciences. It is also necessary to strengthen the teaching of nutrition inuniversities, medical and agricultural faculties, schools of health sciences andother concerned educational institutions.

Population policies

18. Population policies need to have pride of place in the strategy for ensuringadequate nutrition for all, at all times. Countries should devise appropriatepopulation policies, programmes and family planning services to allow prospectiveparents to freely and knowingly determine the number of their children and thespacing of their births, taking into account the interests of present and futuregenerations. Relevant international organizations are encouraged to participateactively in the World Conference on Population and Development to be held inCairo, Egypt, in September 1994.

Health policies

19. Health is an essential element of human development requiring the actionof many social and economic sectors in addition to that of the health sector. Thegross inequality in the health status of people now existing between developed anddeveloping countries as well as within countries is unacceptable and requiresurgent political, social and economic attention. Inadequate health care can haveserious adverse effects on nutritional status. Governments have a responsibilityto protect and promote the health of their people and should formulate nationalpolicies, programmes and services in accordance with the strategy for Health forAll.'

4 Global strategy for Health for All by the year 2000, Health for All Series No. 3 WHOGeneva, 1981.

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Promoting nutritional well-being through strengthened economic andtechnical cooperation among countries

Increased economic and technical cooperation among countries can be ofparticular importance in promoting nutritional well-being. Regional discussionsthat were part of the preparations for the ICN highlighted the value of increasedcooperation among developing countries and within and between regions intackling common problems, in learning from each other's experiences and, wherepossible, in channelling regional resources to regional problems in the spirit ofeconomic and technical cooperation among developing countries. Suchcooperation exists in many regions and must be strengthened with appropriatesupport from international organizations. Increased economic and technicalcooperation among developed and developing countries is also essential to

decrease the existing disparities in the use of food resources.

Allocating adequate resources

To achieve the objective of nutritional well-being, it is essential thatadequate financial, technical and in-kind resources for implementing necessaryprogrammes and projects are provided. Each country should therefore make allefforts to allocate the resources needed for this purpose. As some of theprogrammes might need resources that are currently beyond the capacity of manydeveloping countries, the international community, particularly bilateral agencies,multilateral financing institutions and international organizations, should supportcountry efforts in this direction. Important ways in which the internationalcommunity can assist include an increase in official development assistance inorder to reach the accepted UN target of 0.7 percent of the GNP of developedcountries as reiterated at the 1992 UN Conference on Environment andDevelopment. Economic assistance measures should be'designed in such a waythat they promote the long-term financial and economic stability of a recipientcountry.

HL INTERSECTORAL ISSUES

Improved nutrition requires the coordinated efforts of relevant governmentministries, agencies and offices with mandates for agriculture, fisheries andlivestock, food, health, water and public works, supplies, planning, finance,industry, education, information, social welfare and trade. It also requires thecooperation of universities and research institutions; food producers, processorsand marketers; the health care community; educators at all levels; the media and

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NGOs involved in all of these sectors. Therefore, national intersectoralcoordination mechanisms are needed to ensure the concerted implementation,monitoring and evaluation of policies, plans and programmes. Communityinvolvement is imperative in all aspects of planning and execution of nutritionimprovement activities.

23. Many intersectoral issues must be addressed in policies and programmesto improve nutrition, with close cooperation and coordination by all. Amongthese issues are:

creating, building and strengthening government institutions andcommunity and private infrastnicture to address nutritionalproblems, with special attention given to management and trainingskills;

carrying out a wide range of nutrition training in the agriculture,health, economic and education sectors;

using mass media to increase awareness and promote betternutrition;

strengthening relevant research on identified problems anddeveloping effective interventions through, inter alia, the buildingof institutional capacity and the provision of adequate financialsupport to research;

strengthening educational systems and social communicationmechanisms to improve and implement nutritional knowledge,especially at the individual, family and community levels;

(0 creating better monitoring and surveillance systems andmechanisms related to food, nutrition, health and education toassure positive policy and programme responses to surveillance andmonitoring.

24. These common and essential issues are discussed as appropriate in thethematic areas in the following section of this Plan of Action.

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IV. STRATEGIES AND ACTIONS

The basic goal of protecting and promoting nutritional well-being for allwill be achieved only through a combination of policies involving various sectorsat various levels of responsibility. Based on the worldwide consultations held inpreparation for the ICN, actions to be considered by governments in their effortsto improve nutrition are presented belol,v. These are grouped under nine action-oriented themes, allowing each sector and actor to determine how it can bestaddress nutritional problems, taking into account the specific needs and conditionsin each country.

1. Incorporating nutritional objectives, considerations andcomponents into development policies and programmes

Significant improvements in nutrition can result from the incorporation ofnutritional considerations into the broader policies of economic growth anddevelopment, structural adjustment, food and agricultural production, processing,storage and marketing of food, health care, education and social development.Such policies have an impact on nutrition through food availability and prices,incomes, environmental conditions and health status, care and feeding practicesand other socio-economic factors. Development policies and programmes canalso have varying impacts on the nutritional well-being of different populationgroups.

Efforts to improve nutritional well-being should be based on therecognition of improved human welfare in harmony with the environment andnature as the primary goal of social and economic development. While apopulation's nutritional status is determined by an array of social, economic,environmental and biological factors that affect its ability to acquire, consume andeffectively utilize food adequate for its needs, a healthy well-nourished populationis also essential for successful social and economic development. 'Improvingnutrition should therefore be seen both as a goal of development in its own rightand as a means of achieving it. Recognizing that the sustainable development offood and nutrition security needs to be addressed simultaneously with economicgrowth, governments, in collaboration with all parties concerned and supportedwhere necessary by appropriate legislative measures, should:

(a) Analyse the effects of macro-level policies and sectoral orintegra.ted development plans on nutritional well-being, especiallyof the most vulnerable population groups. This would entail theelaboration of a common understanding of the relative importance

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of various determinants of nutritional status for different populationgroups and of how various policies may affect nutrition throughtheir impacts on food security, health status, care and feedingpractices.

Increase awareness among policy-makers and planners of the extentand severity of nutritional problems and of their causes, of theeconomic benefit of interventions a.nd of how activities under theircontrol can affect the nutritional status of different socio-economicgroups.

In countries where it is appropriate to do so, incorporate clearnutrition goals and components in national development policiesand sectoral plans, programmes and projects, particularly in theareas of food and agriculture, livestock, fisheries, forestry, ruraland urban development, commerce, infrastructure, credit, waterand sanitation, health, education, environmental and social welfare,and adopt benchmarks of success with clear time frames andbudget allocations, as appropriate.

In countries where the operation of the market as a mechanism forthe coordination of production and the consumption of food isrelied upon, develop education and communication programmes sothat nutrition objectives may be achieved through appropriateconsumer choice, based on enhanced consumer awareness andknowledge, and encourage the development of social welfarepolicies that will enable the more vulnerable population groups toexercise informed dietary choice.

Develop or strengthen the technical capacities of, and institutionalmechanisms within, each relevant ministry and at intermediatelevels of government to identify nutritional problems and theircauses and to improve the planning, management and evaluation ofprogrammes and development projects that affect nutrition. Linkswith appropriate research and training institutions should bestrengthened as well.

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Establish a flexible national mechanism with strong technicalsupport to promote effective intersectoral cooperation, to keep thenutrition situation in the country under continuous review and tofacilitate the development of national nutrition policies andprograinines.

Encourage and support the full involvement of communities andthe participation of the people in the identification of their ownnutritional problems as well as in the implementation, monitoringand evaluation of development programmes.

Encourage the private sector, including small-scale producers andprocessors, industry and NGOs to promote nutritional well-beingby considering the impact of its activities on nutritional status.

Assess the impact of new development programmes and projectson nutrition to clearly identify the potential benefits for or risks tonutritional well-being, particularly among vulnerable populationgroups.

Develop and use relevant indicators of nutritional well-being tomonitor progress in social and economic development andestablish appropriate mechanisms to regularly provide informationon the population's nutritional status and factors affecting it,especially that of vulnerable groups, to policy-makers and plannersand all interested sectors, both private and public.

Incorporate appropriate and relevant elements of nutrition in schoolcurricula starting from primary school.

(1) With a view to improving nutrition, direct additional investmentinto agricultural research where necessary to:

address the problem of seasonality through diversification infood production, including fruits and vegetables, livestock,fishery and aquaculture;promote environmentally sound and economically viablefarming systems to increase crop production and maintain soilquality to encourage resource management and resourcerecycling;

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encourage the development of safe biotechnology in animal andplant breeding and facilitate the exchange of new advances inbiotechnology related to nutrition;develop techniques that decrease post-harvest crop losses andimprove food processing, storage and marketing;develop and disseminate technologies that respond to women'sneeds and ease the worldoad of women;improve extension services to cooperate more effectively withfarmer and consumer communities in identifying research needs;improve training methods at the international, national and locallevels to ensure dissemination of new technologies;address the needs of small and poor farmers including thosedependent on poor quality or fragile land;develop technology and systems applicable to small-scaleagriculture;encourage intensive food production at the farm and householdlevels, taking account of prevailing local conditions;develop more effective techniques for the traditional productionof food at the household and community levels.

International, bilateral and regional agencies should assist and strengthennational capabilities to incorporate nutritional considerations into nationaldevelopment in countries where it is appropriate to do so.

2. Improving household food security

Food security is defined in its most basic form as access by all people atall times to the food needed for a healthy life. Achieving food security has threedimensions. First, it is necessary to ensure a safe and nutritionally adequate foodsupply both at the national level and at the household level. Second, it isnecessary to have a reasonable degree of stability in the supply of food both fromone year to the other and during the year. Third, and most critical, is the needto ensure that each household has physical, social and economic access to enoughfood to tneet its needs. This means that each household must have theknowledge and the ability to produce or procure the food that it needs on asustainable basis. In this context, properly balanced diets that supply allnecessary nutrients and energy without leading to overconsumption or wasteshould be encouraged. It is also iinportant to encourage the proper distributionof food within the household, among all its members.

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The right to an adequate standard of living, including food, is recognizedin the Universal Declaration of Human Rights. Food security should be afundamental objective of development policy as well as a measure of its success.Household food insecurity affects a wide cross-section of the population in bothrural and urban areas, The food-insecure socio-economic groups may include:farmers, many of them women, with limited 'access to natural resources andinputs; landless labourers; rural artisans; temporary workers; homeless people;the elderly; refugees and displaced persons; immigrants; indigenous people;small-scale fishermen and forest dwellers; pastoralists; female-headed households;unemployed or underemployed people; isolated rural communities; and the urbanpoor. Increasing the productivity and incomes of these diverse groups requiresadopting multiple policy instruments and striking a balance between short-termand long-term benefits. The choice of policies must be attuned to thecharacteristics of a country's food security problem, the nature of the food-insecure population, resource availability and infrastructural and institutionalcapabilities at all levels of government and communities. Breast-feeding is themost secure means of assuring the food security of infants and should bepromoted an' d protected through appropriate policies and programmes.

Bearing the above in mind, in countries"where the food-chain is not secureand household food insecurity is a problem, governments, NGOs and non-profitorganizations, the private sector and international organizations should, asappropriate, work in a collaborative manlier to:

Adopt development strategies to create conditions for economicgrowth with particular focus on the alleviation of poverty, foodsecurity and sustainable agricultural systems.

Strike an optimal balance between macroeconomic policyobjectives and food security needs, minimize the possible adverseimpact of structural adjustment programmes on the food securityof the poor and, where some negative effects are unavoidable,introduce appropriate measures to alleviate these hardships. In thecountries concerned, governments and international organizationsshould promote programmes that will increase food productionand, where appropriate, agricultural trade, so that poor countriesand poor segments of a population have improved access to food.International lending practices should be re-examined and long-term action must be planned to maintain food supplies at thoselevels required to meet the needs of growing populations.

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(e) Adopt and implement land-use policies where appropriate toenhance food security through the setting aside of adequate areasof agricultural lands and aquatic and other natural resources for theproduction of food and other sources of nutrition.

Adopt policies and programmes to strengthen local leadership,including balanced gender training; enhance communityinvolvement; promote people's participation; develop rural areasto stem rural-urban migration; and empower women, both asproducers and consumers. Women and wornen's organizations areoften very efficient, effective and fundamental in improvinghousehold food security.

Adopt special programmes that will enhance productivity with aview to reducing costs and increasing and stabilizing productionand incomes of the poor. Such programmes could includeimproving the access of small-scale producers to inputs, credit andother essential servi-ces, as well as to markets through improvedinfrastructure. The role of agricultural cooperatives and effectiveextension services in increasing production and producer incomesshould be stressed.

(t) Improve access to work opportunities or production factors forurban and rural workers, female heads of households, thoseemployed in the informal sector and unemployed andunderemployed people by stimulating the creation of jobs,increasing their skills, providing credit on easy terms andincreasing the availability of improved technologies, other inputsand means of production.

Improve access to land and other natural resources by introducingand implementing agrarian reforms and, in particular, through theeffective implementation of tenancy reforms and the promotion ofefficient utilization of agricultural resources and resettlement innew lands, wherever feasible. Such actions must be taken in fullcompliance with applicable international laws and agreements.

Increase employment opportunities, particularly in rural areas, byencouraging the private sector to augment such opportunities inagriculture, industry, handicraft and business.

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(i) Stabilize food supplies through adequate stockholding in the formof strategic food security reserves as a first line of defence inemergencies; improve post-harvest handling, packaging, storage,preservation, transport a.nd distribution of food to reduce losses atall stages; enhance animal health and production possibilitiesincluding fish farming and attention to fisheries resources; ensurea stable supply of fuel for cooking meals; carry out research andintroduce mea.sures to improve production, utilization andpreservation of indigenous and traditional foods; improve ruralfood processing technologies; increase marketing facilities at thevillage, cottage and industrial levels to smooth the food supplyflow throughout the year; introduce a variety of croppingstrategies, such as crop rotation, mixed cropping, biological inputsand planting of perennial fruit-bearing trees, and develop otheragroforestry approaches; ensure an adequate supply of clean andsafe water; promote household and community gardens; andensure the sustainability of food supplies by employing productionand marketing systems based on safe and renewable resources thatprotect the environment and biodiversity.

(i) Improve emergency-preparedness planning through: effective earlywarning and other information systems; food security reserves;preparation of contingency plans of action to meet emergencies;and enhancing the entitlement of affected people through, forexample, public-works programmes; as well as introduce measuresto prevent natural disasters, such as irrigation schemes, floodcontrol schemes, etc. In this respect, the international communitycan play an important role by providing timely and well-targetedfood aid and other technical and financial assistance, particularlyin the forin of food-for-work programmes and for rehabilitation.Coordinated action of relevant organizations of the UN system isof particular importance in this context. Food aid should notinterfere with, or be considered as a substitute for, local foodproduction. The special needs of refugees and displaced persons,these include people affected by wars, civil unrest or naturaldisasters, should be given priority attention in food aidprogrammes. The provision of food supplies should strive to meetminimal nutritional requirements. NGOs can also providesignificant help through effective and appropriate disaster

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management training at all levels, early warning, food andnutrition surveillance schemes, nutrition education, resourcemobilization and action-oriented programme implementation.

(k) Strengthen planning of food-related assistance programmes so thatthey reach the population in need without disrupting the localeconomy or local food habits including food production andmarketing. Such programmes could include food distributionsystems, particularly for the poor and unemployable, and incometransfer schemes, such as targeted food subsidies, food stamps andfeeding programmes for vulnerable groups with a view topromoting nutritionally adequate diets. In particular, introduce self-targeting food distribution and income transfer schemes for thosefoods consumed primarily by the poor by locating public fooddistribution centres in areas where the poor live, taking intoaccount that these populations should be able to select nutritionallyadequate diets from the range of foods available.

(1) Strengthen the coping mechanism of the household to meetemergencies by improving its capacity to protect itself from theimpact of an emergency through, for example: household andcommunity food storage; group savings and credit schemes;diversification of income and employment sources; and improvedmarketing infrastructures. Action could also include helping thehousehold when the emergency occurs, for example, by supplyingseeds for growing short-term crops, by providing food aid,livestock feed and water and, when the emergency is over, byintroducing rehabilitation measures to help the household recoverfrom adverse effects of the emergency.

(m) Adopt or strengthen a public sector policy supporting labour-intensive public works programmes and programmes to reducegeographical isolation, especially in sub-Saharan Africa wherepriority actions are needed to quickly alleviate acute nutritionalproblems. Labour-intensive infrastructure programmes are one ofseveral valuable instruments that may be used to improveemployment, income and access to food. They transfer andstabilize benefits, thus decreasing the risk of consumption shortfallsamong the poor, and can strengthen needed infrastructure, such as

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roads, to facilitate better trade and movement of foods from ruralto urban centres, promote resource conservation or irrigation andland development or combat such problems as desertification.

Encourage necessary research by governmental, international andprivate institutions to promote household food security throughbetter food production, handling and storage and prevention offood losses, crop and genetic diversity, and improved foodprocessing, preservation and marketing. Research should be doneon household handling of food and intrafamily food distribution toassure adequate food availability and to protect the nutritional valueof food and prevent food losses and wastage. Such research canenhance rural employment and promote the role of women, inparticular, in all aspects of food production, processing andmarketing. Research should also be carried out on appropriatecost-effective indicators to measure household food securityproblems and to measure progress of appropriate programmes insolving those problems.

Promote better general and nutritional education to eliminateilliteracy and improve knowledge in the selection of a safe andadequate diet and of food production, processing, storage andhandling techniques at all levels, especially the household level.Programmes should be directed at household leaders, withparticular focus on women, and should also include homeeconomics education for both boys and girls. The awareness ofmen and women of the' benefits of limiting household size and theadvantages of family planning practices should be increased. Therole of mass media in delivering positive nutrition improvementmessages and eliminating harmful food taboos should beemphasized. It is important to develop and carry out publicinformation campaigns to improve the quality of nutrition throughbetter use of available food supplies by the households and topromote recognition of the fact that each member of a householdshould be able to share fairly in available food resourcesirrespective of sex, age or any other individual characteristic.

International financial and specialized agencies should give highpriority to assisting countries with their programmes forstrengthening household food security. The nature of such supportmay be increased investment in production enhancement projects

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such as irrigation, soil fertility improvement and soil and waterconservation, intensification of agriculture or assisting countriesundertaking structural adjustment. Assistance should also includetechnology transfer adapted to the local conditions in developingcountries to improve food production and processing whileprotecting intellectual property rights as appropriate; the trainingof personnel at all levels; and the establishment of a suitableeconomic environment to improve the competitiveness ofdeveloping countries.

3. Protecting consumers through improved food quality and safety

32. A safe food and water supply of adequate quality is essential for propernutrition. The food supply must have an appropriate nutrient content and it mustbe available in sufficient variety and quantity. It must not endanger consumerhealth through chemical, biological and other contaminants and it must bepresented honestly. Food safety and quality control ensures that the desirablecharacteristics of food are retained throughout the production, handling,processing, packaging, distribution and preparation stages. This promotes healthydiets, reduces food losses and encourages domestic and international food trade.Food quality encompasses the basic composition of foods and aspects concerningfood safety. Consumers have the right to a good quality and safe food supply,and government and food industry actions are needed to ensure this. Effectivefood quality and safety control programmes are essential and may comprise avariety of measures, such as laws, regulations and standards, together withsystems for effective inspection and compliance monitoring including laboratoryanalysis. Where appropriate, governments, in close collaboration with otherinterested parties, should:

Adopt and strengthen comprehensive measures to cover the controlof food quality and safety with a view to protecting the health ofconsumers and producers and ensuring sound production, goodmanufacturing and fair trade practices. Where measures exist theyshould be regularly reviewed and updated, as appropriate, forbetter producer and consumer protection.

Establish measures to protect the consumer from unsafe, lowquality, adulterated, misbranded or contaminated foods.Measures should include provisions for minimum acceptable levelsof food quality and safety, for differences in the ways in whichfood is produced, processed, packaged, labelled and stored, as well

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as for the conditions under which it is presented and purveyed.Food regulations should also cover the fortification of foods withmicronutrients and should fully take into account the recommendedinternational standards of the Codex Alimentarius Commission.Food labels should be clear and easy to understand and attentionshould be given to harmonizing labelling requirements; betterinformation on nutrient analysis and food composition is needed forthis task. Measures to assist individuals with food intolerancesshould be considered. Claims in food labelling or advertisingshould be carefully controlled and false or misleading claimsshould be prohibited. FAO and WHO should encourage greaterinvolvement of developing countries in Codex activities and reviewavenues to facilitate such participation and they should findappropriate means of making contact with concerned food controlinstitutions and provide them with information and technicalknowledge in this field.

Give high priority to establishing food safety and quality controlinfrastructures, including food inspection, sampling and laboratoryfacilities to enforce the law and regulations, to ensure that foodproducts comply with applicable requirements for domesticconsumption or export.

Give consumer and producer organizations rights of consultationwith advisory and decision-making bodies and facilitate open andtransparent access to information and participation in the

establishment of food safety, quality control and labellingstandards. Also, establish or strengthen mechanisms to resolveconsumer problems with the food supply. Cooperation should befostered among the food sector, government and consumers.

Establish effective working relationships with the food industry,including producers, processors and purveyors of food, in order toensure that food industry quality control systems are adequate tosecure compliance with requirements of the law and regulations.Primary responsibility for production, manufacturing and

distribution of the food supply rests with the farming, agriculturalprocessing and retailing sectors. Thus the food industry shouldprovide safe, wholesome, nutritious and palatable foods so that thehealth of consumers is protected.

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(0 Support international and multilateral efforts to extend and enhancefood standards and food-labelling programmes. Developingcountries should be provided with international technical assistanceto improve their food safety and quality programmes for domesticmarkets and international trade.

Develop the human resources required for designing, implementingand monitoring food and water quality control systems. Educationand training in the safe handling of agrochemicals are essential forfarmers and for food handlers, both commercial and domestic.

Implement, through national legislation, regulation and otherappropriate tneasures, existing international agreements on themarketing and distribution of agrochemicals, such as theInternational Code of Conduct on the Distribution and Use ofPesticides.

Promote the development of sustainable and ecologically soundagricultural practices and integrated pest management andstrengthen research and extension programmes that help facilitatetheir adoption. Techniques that help reduce the use of agriculturalchemicals should be encouraged.

(i) Support consumer education to contribute to an educated andknowledgeable public, safe practices in the home, communityparticipation and active consumer associations. FAO and WHOshould provide member countries with material on food quality andsafety for use in consumer education programmes.

(k) Promote research on food quality and safety, including weaningproducts and street foods, taking into account the socio-economicconditions of production, handling and storage technologies.

(1) Develop surveillance and monitoring programmes for food-bornediseases and contaminants.

(m) Ensure that foods for emergency feeding programmes for refugeesand displaced persons are of good quality and safe forconsumption. Mechanisms should be established to monitorspecific problems such as pest infestation, contaminants andproduct age and to promote the exchange of relevant information.

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4. Preventing and managing infectious diseases

33. The interaction of infection and malnutrition has an overwhelming impacton health status, particularly in lower socio-economic groups. It is a major causeof death, sickness and disability in infants and young children and an importantcontributor to women's ill health and reproductive problems. Preventing,controlling and correctly managing infections improves nutritional well-being andmarkedly enhances the productivity of the adult population. Governments, incooperation with all concerned parties, should:

Adopt or strengthen, as appropriate, measures to ensure that safefood and safe water supplies are readily available in sufficientquantities to provide adequate environmental sanitation for all andto improve waste disposal systems.

Prevent food-borne and water-borne diseases and other infectionsin infants and young children by encouraging and enabling womento breast-feed exclusively during the first four to six months oftheir children's lives.

Promote sound weaning practices by encouraging the use ofnutritionally adequate, safe and appropriate locally available foods.

Provide or strengthen, as appropriate, specialist education forhealth workers and general education and specific nutrition andhealth information for communities, parents and individuals,enabling them to provide safe and adequate diets and effectivelyprevent and manage infections. This would include providingtraining and information on food, sanitation and primary healthcare, particularly the management of diarrhoea, and on dietaryneeds throughout the life cycle, including periods of illness, forrelevant health, agriculture and other extension workers at alllevels.

Prevent, control, eliminate and/or eradicate infectious, parasiticand other communicable diseases, including those spread by animalvectors, by improving the environment and ensuring adequateprimary health care services, including immunization programmes,diarrhoeal disease control, control of acute respiratory infectionsand extending AIDS prevention and control programmes to allpopulations.

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Encourage intersectoral collaboration between agriculture, healthand other relevant sectors to prevent and control infectiousdiseases, especially zoonoses. Close collaboration with NGOs andthe private sector should be ensured.

Ensure and support nutrition management, where shown to beeffective, in the prevention and reduction in severity of infectiousdiseases.

Promote research on nutrition-related aspects of transmission andmanagement of infectious diseases, taking into account all socio-economic aspects, and ensure the application of relevant findings.

5. Promoting breast-feeding

34. Breast-feeding provides infants and young children with the ideal nutrition.Together with its many beneficial effects, such as those on child spacing and theprevention of disease, it is the most inexpensive form of infant feeding. Allwornen should be enabled to breast-feed their babies exclusively for the first fourto six months, and, while giving appropriate supplementary food, to continuebreast-feeding for up to two years or more. In order to do so, the internationalcommunity needs to create awareness and provide maximum support to womento breast-feed, and governments and concerned parties of the private sectorshould:

Support and encourage mothers to breast-feed and adequately carefor their children, whether formally or informally employed ordoing unpaid work. ILO conventions and regulations covering thissubject may be used as a starting-point for the States that agreewith these conventions and regulations.

Make all efforts to have maternity facilities take part in the "BabyFriendly Hospital Initiative" of WHO and UNICEF, incorporatingthe good practices described in the joint WHOTUNICEF statementon protection, promotion and support of breast-feeding throughimproved maternity services. These sound practices should also beused as a guideline as adapted to home deliveries.

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Encourage and support collaboration between health care systemsand mother-support networks, including the family and thecommunity, if necessary by promoting the establishment of mother-support groups.

'nice actions to give effect to the principles and aim of theInternational Code of Marketing of Breast-Milk Substitutes, asadopted by the 1981 World Health Assembly and reconfirmed bysubsequent World Health Assembly resolutions.

Ensure that health and other care providers receive high qualitytraining in breast-feeding issues, using updated training material,and that they are informed about relevant national marketingregulations or policies.

Ensure as far as possible that information disseminated on thefeeding of infants and young children is consistent and in line withcurrent scientific knowledge and take steps to counteractmisinformation on infant feeding.

Consider with utmost care issues regarding breast-feeding andhuman immunodeficiency virus (HIV) infection on the basis of themost up-to-date, authoritative scientific advice and referring to thelatest WHO/UNICEF guidelines, and request that WHO, in closecooperation with UNICEF, breast-feeding and other experts,convene technical meetings on a regular basis to review the latestscientific publications on these issues and update the guidelines.

6. Caring for the socio-econornically deprived and nutritionallyvulnerable

35. Care refers to the provision in the household and community of time,attention, support and skills to meet the physical, mental and social needs ofsocio-economically deprived and nutritionally vulnerable groups. Among thesegroups the growing child is the most vulnerable, but others include women, theelderly and the mentally, physically and sensory disabled. Among the socio-economically deprived are refugees, displaced persons, some indigenous peoples,those in isolated communities, the landless, the unemployed, recent immigrants,orphans and children in difficult circumstances. Individuals most at risk ofmalnutrition are those who are both physiologically vulnerable and socio-economically deprived. Countries should recognize that the skills and abilities of

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the care giver, who is usually the mother, are crucial to the quality of care,particularly the selection and preparation of food for the family, including themother herself, the children and other dependents.

36. In general, the provision of care is primarily a responsibility of the family.However, society also has an obligation to assist those who cannot care forthemselves. The role of government should be to provide a supportiveenvironment for family- and comtnunity-based care and to provide direct serviceswhen additional care is needed. Care within the family includes support duringand after pregnancy, breast-feeding, providing security, reducing child stress,providing shelter and clothing, feeding and bathing, preventing and treating illnessand showing affection and respect. Care facilities outside the family includecurative and preventive health clinics, prenatal and maternal care centres,traditional healers or members of extended family networks, community andgovernment social and economic support systems and programmes for incomegeneration. Caring should recognize the dignity and rights of vulnerable people.Actions to improve the-care of the socio-economically deprived and nutritionallyvulnerable will be most successful if they are sensitive to the particular needs andtraditions of a local community and respond to these. Governments areencourage-d to work in a collaborative manner with local community groups, theprivate sector and NG0s. Governments, in cooperation with other concernedparties, should:

Ensure that all infants and young children, particularly children indifficult circumstances, have access to adequate, well-balanced andsafe diets, health care and education to enable them to attain andmaintain their full physical and mental growth potential and propernutritional status. Particular attention should be given to care forthe female child.

Promote sound weaning practices, including timely introduction ofsupplementary foods, adequate quantity and quality of weaningfoods and improved feeding practices, such as more frequent andsupervised feedings.

Enhance the legal and social status of woinen from birth onwards,assuring them of respect and equal access to caring, education,training, land, credit, equity in wages and remuneration and otherservices, including family planning services, and empower themeconomically so that they have better control over the familyresources.

- 40 -

Promote support of care givers to preserve their physical andmental health and enhance their slcills and lcnowledge to improvenutrition. Decrease women's workload by supporting research andextension services on time- and energy-saving devices, whereapplicable.

Adapt nutrition, health and education support services to adolescentgirls and boys to prepare them to fulfil their future roles as well-nourished, productive adults and parents.

Prepare and motivate adult males to fully participate in and takeresponsibility for the nutritional well-being and support of theirfamilies, as well as to be sensitive to women's needs in protectingand promoting family well-being.

Foster recognition of the contribution that the elderly make to thehousehold and community activities. Promote caring of the elderlythrough traditional forms of family support and through theintroduction of special measures where needed.

Provide care for disabled individuals to enable them to reach theirpotential and become self-supporting, ensuring their opportunitiesin education, employment and housing.

Enhance the nutritional status of the indigenous people through thedevelopment and implementation of culturally acceptable strategiesthat involve the community.

(i) Encourage and foster community awareness, organization andleadership to promote and ensure its own nutritional developmentincluding adequate care of its vulnerable households andindividuals, such as fernale-headed households.

(k) Enhance food and nutrition programmes directed at urban poor andespecially street children.

37. Among refugees and displaced populations, high rates of malnutrition andmicronutrient deficiencies associated with high rates of mortality continue tooccur. The magnitude of the problem has grown over the last decade. Increasedpolitical commitment to and accountability for the protection and promotion of thenutritional well-being of refugees, displaced populations, those under occupation,

38. Micronutrient deficiencies are a matter of major public health concern.They are widespread, although the prevalence of a particular deficiency can vary

- 41 -

prisoners of war and other affected groups are urgently required in accordancewith international humanitarian law. Governments, in collaboration with theinternational community, should:

Provide sustainable assistance to refugees and displaced personsand work to monitor and ensure their nutritional well-being, givinghigh priority to the control of diseases and to the prevention ofmalnutrition and outbreaks of micronutrient deficiency diseases.Wherever feasible such assistance should encourage their ability tosupport themselves rather than increase their dependence onexternal assistance. The food provided should be nutritionallyadequate and safe.

Identify, within civilian populations situated in zones of conflict,refugee and displaced populations and groups needing special careincluding the disabled, the elderly, children, mothers and othernutritionally vulnerable groups in order to plan to provide for theirspecial needs.

Promote the basic human rights of refugees and displaced persons.

Ensure a rapid, coordinated and appropriate response by improvingcommunications with the international community, includingconcerned entities of the United Nations as well as NG0s.

Work to ensure the safe and timely passage of the totality of foodand medical supplies to those in need in conflict zones, and thecreating and using of "humanitarian corridors of tranquillity"where available.

Ensure assistance to refugees returning to their home countriesuntil they are reintegrated into society.

Make efforts to develop policies that ensure stability so as to avoidthe massive migration of refugees and displaced persons, whichcauses additional pressure on any community.

7. Preventing and controlling specific rnicronutrient deficiencies

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considerably within and between countries. Deficiencies of vitamin A (includingbeta-carotene), iodine and iron are especially important because of their serioushealth consequences, wide geographic distribution and the existing globalcommitment to their control.

Vitamin A deficiency and its consequences, including blindness, poorgrowth, increased severity of infections and death, are fully preventable, makingits control one of the most effective child health and survival strategies thatgovernments can undertake. The protection, promotion and support of breast-feeding is an effective way of preventing vitamin A deficiency in infants andyoung children.

Over one-fifth of the world's population lives in iodine-deficient areas. Itis the most common preventable cause of mental retardation. Additionalconsequences of iodine deficienty are reproductive failure, goitre, increasedmortality and economic stagnation. Children, adolescent girls and women areparticularly vulnerable. The means for its correction are readily available andprovide an exciting opportunity for its elimination by the year 2000.

Iron deficiency and/or anaemia is the most common micronutrientdeficiency, especially affecting young children and women of reproductive age.Uncorrected anaemia can lead to learning disabilities, an increased risk ofinfection and diminished work capacity and to death of women during pregnancyand at childbirth. Thus, iron deficiency has an impact on all segments of society.

Deficiencies of other micronutrients such as folate and other B-complexvitamins, vitamin C, selenium, zinc and calcium also significantly affect healthand may merit increased attention by governments in countries where deficienciesexist.

Recognizing the international, regional and national resources, coordinationand support required, governments, in collaboration with international agencies,NG0s, the private sector/industry, other expert groups and the community, shouldadopt an appropriate combination of the following strategies:

(a) Assess the extent and epidemiology of rnicronutrient deficienciesand develop a national policy for prevention based on theirdistribution and cause, the severity of deficiency and availableresources.

- 43 -

(b) Accelerate efforts to achieve the elimination of vitamin A andiodine deficiencies and a reduction in iron deficiency in accordancewith the year 2000 goals of the World Summit for Children andthe Montreal Conference on Micronutrient Malnutrition.

(e) Formulate and implement programmes to correct micronutrientdeficiencies and prevent their occurrence, promoting thedissemination of nutrition information and giving priority to breast-feeding and other sustainable food-based approaches that encouragedietary diversification through the production and consumption ofmicronutrient-rich foods, including appropriate traditional foods.Processing and preservation techniques allowing the conservationof micronutrients should be promoted at the community and otherlevels particularly when micronutrient-rich foods are available onlyon a seasonal basis.

Implement the most appropriate combination of the followingmeasures: improved food availability, food preservation, food andnutrition education and training, dietary diversification, foodfortification, supplementation and pertinent public-health measuressuch as primary health care, promotion of breast-feeding and safedrinking-water. International and regional cooperation in thesharing of resources to enable economies of scale should beencouraged.

Ensure that sustainable food-based strategies are given first priorityparticularly for populations deficient in vitamin A and iron,favouring locally available foods and taking into account local foodhabits. Supplementation of intakes with vitamin A, iodine and ironmay be required on a short-term basis to reinforce dietaryapproaches in severely deficient populations, utilizing primaryhealth care services when possible. Supplementation should bedirected at the appropriate vulnerable groups, especially women ofreproductive age (iodine and iron), infants and young children, theelderly, refugees and displaced persons. Supplementation shouldbe progressively phased out as soon as micronutrient-rich food-based strategies enable adequate consumption of micronutrients.

Ensure and legislate for the fortification of foods or water withnecessary micronutrients, where feasible, when existing foodsupplies fail to provide adequate levels in the diet. Fortification

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should be regularly evaluated for various reasons. Where iodinedeficiency is a significant public health problem, the iodization ofall salt for both human and livestock consumption is required,recognizing that this is the most effective long-range measure forcorrecting iodine deficiency.

Ensure that nutrition education and training programmes areimplemented at the community, school and national levels toprovide information on proper food preparation, nutritional valueand bioavailability and other factors that affect micronutrientstatus, especially of the young, and to promote the consumption offoods that are rich in micronutrients.

Strengthen micronutrient surveillance capabilities and activities bydevising indicators to monitor the above strategies for achievingnational goals related to coverage, compliance and effectiveness intargeted populations.

Support research on the role of micronutrients in health anddisease; on the development of inventories and food compositiontables of existing and potentially significant food sources ofmicronutrients, including inter alia green and yellow vegetablesand fruits, palm oil, fish and other locally available food sourcesof micronutrients; on vveaning foods; on factors affecting thebioavailability of nutrients in food; on indigenous methods of foodprocessing and preparation affecting inicronutrient availability; onnutrition education; and on the improvement of existing techniquesfor the assessment and correction of micronutrient deficiencies.

Develop sustainable institutional capacities and human resources,including training of professionals, non-professionals andcommunity leaders, in order to achieve the goals of micronutrientdeficiency control and prevention.

(k) Consider, as appropriate, coordinating micronutrient deficiencycontrol activities under the direction of a national committee, withthe appropriate political support, authority, legislation and

infrastructure that reflects national commitment.

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(1) Encourage FAO, WHO and all other concerned internationalagencies and NGOs to provide assistance in combating all aspectsof micronutrient deficiency problems, through monitoring andsurveillance, research and production and consumption ofmicronutrient-rich foods.

(m) Recognize that refugees and displaced persons, as well as beingsusceptible to iodine, vitamin A and iron deficiencies, are alsosusceptible to other deficiencies, particularly vitamin B/ deficiency(beriberi), niacin deficiency (pellagra) and vitamin C deficiency(scurvy). Donor countries and involved organizations musttherefore ensure that the nutrient content of food used foremergency food aid meets nutritional requirements, if necessarythrough fortification or ultimately through supplementation. To theextent possible, such foods should be culturally appropriate.

8. Promoting appropriate diets and healthy lifestyles

Non-communicable diseases related to unhealthy lifestyles andinappropriate diets are becoming increasingly prevalent in many countries. Withgreater affluence and urbanization, diets tend to become richer on average inenergy and fat, especially saturated fat, have less fibre and complexcarbohydrates and more alcohol, refined carbohydrates and salt. In urban settingsexercise and energy expenditure frequently decrease, while levels of smoking andstress tend to increase. These and other risk factors, as well as increased lifeexpectancy, are associated with the increased prevalence of obesity, hypertension,cardiovascular diseases, diabetes mellitus, osteoporosis and some cancers withimmense social and health care costs. Dental caries is also an important diet-related condition in some regions.

While generally positive, urbanization, particularly in developingcountries, can lead to severe economic and social stresses among poorpopulations. Often, too rapid urban growth results in heavy demands on urbanfacilities, resulting in large numbers of poor people living in crowded slums withlimited access to clean water, sanitation facilities, health care and food.Excessive urbanization, particularly rural-urban migration, may also contributeto the fragmentation of society and the breakdown of traditional values and careand feeding practices. Dietary and lifestyle changes following migration to moreaffluent areas can affect health status in positive and negative ways, oftenexposing immigrants, particularly minorities, to an increased risk of diet-related

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non-communicable diseases. Both primary and secondary prevention of thesediseases are important. Governments, together with other groups, should:

Assess the dietary intake and nutritional status of the population(see section 9 below).

Assess the strength of evidence between diet and disease in thecontext of their own situation, talcing into account international andother national assessments, and current scientific findings.Consider which dietary targets are appropriate in the context ofthe prevalence of deficiency and diet-related chronic diseases.

Develop comprehensive policies for improved food supplies andnutrition, adapted to local conditions in each country, and supportand encourage home gardens, traditional food production andconsumption patterns that support nutritional well-being.

On the basis of energy and nutrient recommendations, provideadvice to the public by disseminating, through the use of massmedia and other appropriate means, qualitative and/or quantitativedietary guidelines relevant for different age groups and lifestylesand appropriate for the country's population.

Implement and support the design of appropriate community-basednutrition education programmes in conjunction with appropriatecommunication strategies, such as nutrition labelling, that enableindividuals and families to chose a healthy diet, and give highpriority to ensuring that these programmes reach target groups.

Encourage the adaptation of nutrition and consumer informationand intervention programmes to differences in socio-economicconditions, language barriers and cultural beliefs and attitudesregarding foods, health and disease.

(g) Promote from an early age a knowledge of food and nutrition, foodsafety, food preparation, healthy diets and lifestyles through thecurricula of schoolchildren, teachers, health professionals, and thetraining of personnel involved in agricultural extension.

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Encourage institutionalized food services and the catering sector toprovide and promote healthy diets.

Take appropriate actions to discourage smoking, drug and alcoholabuse.

Sponsor and promote exercise programmes to all, targetingchildren and high-risk groups, and provide recreation and sportingfacilities with the participation of community, public and privateorganizations.

(k) Promote employment and better living conditions in rural areas toprevent excessive migration to cities.

(1) Support special nutrition and consumer education, nutritioninterventions and follow-up activities for those groups ofimmigrants that may need special attention.

9. Assessing, analysing and monitoring nutrition situations

46. Information on the nature, extent, magnitude and severity of differenttypes of nutritional problems, as well as their causes, resources and how they arechanging over time, is essential for the development, implementation, monitoringand evaluation of effective policies and programmes to improve nutrition.Information is also needed to provide early warning of impending nutritionalemergencies and for on-going programme management. The basic aim should beto provide relevant and accurate information that can be utilized efficiently.Therefore, information must be timely, relevant to the decision-makers andcommunicated effectively at the appropriate levels. These levels range from theindividual and household level, through the community and national levels, to theinternational level. Open access to information regarding the nutritional situationmust be ensured for all interested parties. Utilization of information may befacilitated by the establishment or strengthening of specific bodies or mechanisms.Data collection and analysis have costs that must be balanced against the overallresources available for the programme. Governments, in close cooperation withall parties concerned, should:

(a) Identify the priority nutritional problems in the country, analysetheir causes, plan and implement appropriate remedial actions andmonitor and evaluate efforts to improve the situation. This would

- 48 -

include selecting appropriate indicators and methods for assessingand monitoring problems of food security and undernutrition,micronutrient deficiencies and overnutrition.

Establish or strengthen data collection, analysis and reportingsystems within appropriate institutional frameworks in a sustainablefashion in order to meet the relevant priority information needs ofplanners, policy-malcers, programme managers and communities asthey address nutritional problems.

Provide basic and on-going training of personnel in relevantministries and institutions for data collection, analysis, presentationand utilization.

Make maximum use of existing data sources and informationsystems to avoid duplication of efforts and to encourage acoordinated multisectoral approach for taking action. Relevantsources of data could be in particular the rninistries responsible foragriculture, health, education, commerce and trade, finance andplanning, scientific research . and social welfare, as well asuniversities, the private sector and NG0s. Data could includeinformation on mortality, morbidity, anthropometry, foodavailability, food intake, food prices, breast-feeding, food qualityand safety, along with information on lcnowledge, attitudes andpractices, family size and income, rainfall and landholding.

Encourage the development and use of innovative approaches suchas risk mapping, sentinel sites and rapid appraisal techniques forinformation gathering and utilization. Establish a system for theexchange of information between developing countries (South-South) and also between developed and developing countries fortraining and research.

(0 Promote community-based information systems to support localproblem identification analysis and action.

(g) Develop and strengthen growth monitoring and promotion andnutrition surveillance within primary health care systems.

(b) Within the context of the national plans of action, governmentsshould formulate, adopt and implement programmes and strategiesto achieve the recommendations of the Plan of Action for

- 49 -

Promote the strengthening of research and training of personnel innutrition, especially for food sciences, nutrition, biology, foodtoxicology, epidemiology, human and social sciences and relatedinterventions.

Cooperate with other governments, research institutions, NGOsand international organizations to promote and support regional andinternational collaboration in gathering food and nutritioninformation and in surveillance and early warning activities. Thisshould also include the building of capacities within countries andpromoting the establishment of focal points for training andresearch at national and regional levels.

(i) Support and encourage, where appropriate, the development anduse of local food composition information.

V. RESPONSIBILITY FOR ACTION

47. The goals of the World Declaration on Nutrition as well as therecommendations of the Plan of Action for Nutrition need to be translated intopriority actions in accordance with the realities found in each country and mustbe supported by action at the international level. Taking these into account,governments should prepare national plans of action, coordinated as appropriatewith follow-up activities related to the World Summit for Children, establishingpriorities, setting up time frames and, where appropriate, identifying the resourcesneeded and those already available. The strategies for achieving the objectivesmay vary from country to country, and the responsibilities rest with a variety ofagents, from government institutions to individuals.

1. At the national level

(a) All governments should establish appropriate national mechanismsto prioritize, develop, implement and monitor policies and plansto improve nutrition within designated time frames, based both onnational and local needs, and provide appropriate funds for theirfunctioning.

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Nutrition, talcing into account their specific problems andpriorities. In particular, in countries where it is appropriate to doso, ministries of agriculture, fisheries, food, health, social welfare,education and planning, as well as other concerned ministries,should formulate concrete proposals for their sectors to promotenutritional well-being.

Governments at the local and provincial levels, as well as NGOsand the private sector, should be encouraged to participate in theprocess.

All sectors of society should be encouraged to play an active roleand to assurne their responsibilities in implementing relatedcomponents of the national plan of action, with appropriatemechanisms for coordination. Households, communities, NG0s,private institutions including industry, small-scale producers,women farmers and trade and services, as well as social andcultural associations and the mass media should be mobilized tohelp individuals and population groups achieve nutritional well-being in close association with government and technical servicesectors.

Programmes aimed at improving the nutritional well-being of thepeople, in particular that of the gr9ups at greatest risk, should besupported by the allocation of adequate resources by the public andthe private sectors so as to ensure their sustainability.

Governments, academic institutions and industry should support thedevelopment of fundamental and applied research directed towardsthe improving the scientific and technological knowledge baseagainst which food, nutrition and health problems can be analysedand solved, giving priority to research concerning disadvantagedand vulnerable groups.

In most countries, nigh priority should be given to the developmentof human resources and training of personnel needed in all sectorsto support nutrition-related activities.

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(h) National governments, in cooperation with local authorities,NGOs and the private sector, should prepare periodic reports onthe implementation of national plans of actions, with clearindications of how vulnerable groups are faring.

2. At the international level

International agencies multilateral, bilateral and non-governmental are urged to define, in the course of 1993, stepsthrough which they can contribute to the achievement of thosegoals and strategies set out in the World Declaration and Plan ofAction for Nutrition, including the promotion of new partnershipsof economic and technical cooperation among countries.

The governing bodies of FAO, WHO, UNICEF, the World Bank,UNDP, Unesco, ILO, WFP, UNFPA, UNHCR, UNU, IFAD andother concerned international organizations should, in the courseof 1993, decide on ways and means of giving appropriate priorityto their nutrition-related programmes and activities aimed atensuring, as soon as possible, the vigorous and coordinatedimplementation of activities recommended in the WorldDeclaration and Plan of Action for Nutrition. This would include,as appropriate, increased assistance io the member countries. FAOand WHO, in particular, should strengthen within availableresources their programmes for nutritional improvement, takinginto account the recommendations put forth in this Plan of Action.

Regional offices of UN organizations and regionalintergovernmental organizations are requested to collaborate on andto facilitate the implementation and monitoring of the Plan ofAction for Nutrition by supporting horizontal and interregionalcooperation, especially among developing countries. In particular,this would involve collaboration based on the aims and principlesof the Plan of Action for Nutrition for the formulation of overallregional strategies for improved nutrition and, when requested, forassisting governments in formulating national plans of action.

Regional institutions for research and training, with appropriatesupport from the international community, should establish orreinforce collaborative networks in order to foster the humanresource development needed particularly at the national level

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to implement the Plan of Action for Nutrition, to promoteintercountry collaboration and to exchange information on the foodand nutrition situation, technologies, research results, theimplementation of nutrition programmes and resource flows.

As leading specialized agencies of the UN system in the fields offood, nutrition and health, FAO and WHO are requested to preparejointly, in close collaboration with UNICEF and other UN entities,a consolidated report on their implementation of the WorldDeclaration and Plan of Action for Nutrition and also on itsimplementation by their member countries and other internationalorganizations for review by their governing bodies by 1995. Thegoverning bodies can then make decisions on the timing of futurereports.

UN agencies have a special responsibility for follow-up. Allconcerned agencies and organs of the UN system are urged tostrengthen their collaborative and cooperative mechanisms in orderto fully participate at international, regional, national and locallevels in the achievement of the objectives of the Plan of Actionfor Nutrition. The ACC/SCN should facilitate coordination of theseefforts and, in close collaboration with its participating agencies,prepare periodic reports on their activities in implementing theWorld Declaration and Plan of Action for Nutrition forconsideration by the ACC for submission, through ECOSOC, tothe UN General ASseinbly.

VI. RECOMMENDATIONS FOR THE FOLLOW-UP OF THECONFERENCE

48. Governments are urged to promote continued work by relevant ministriesand the strengthening or establishment of the ICN focal points where appropriate,and, with other concerned parties, to' improve nutritional status, including thefollowing:

(a) To prepare or improve, as early as possible and not later than theend of 1994, national plans of action and policies based on theprinciples and strategies enunciated in this World Declaration andPlan of Action. These need to be based on an analysis of thecountry situation and developed with the active participation of all

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relevant ministries, local governments and communities, non-governmental and research organizations and the private sector.

(b) To allocate and mobilize the financial and human resourcesnecessary for implementation.

(e) To prepare, where appropriate, specific proposals for researchpriorities and capacity building, establishing links betweengovernment, non-governmental sectors, appropriate organizationsand academic institutions.

To develop coordinated intersectoral mechanisms forimplementing. monitoring and evaluating the agreed national planof action.

To disseminate to the public, which may include parliamentarybodies, information on the principles and objectives of the WorldDeclaration and Plan of Action for Nutrition as well as on theprogress made and targets reached.

(0 To strengthen collaboration with NG0s, community agencies, localprivate sector representatives and citizens on the design andimplementation of the country action plan.

The international community, including bilateral, international andmultilateral agencies and institutions providing capital and/or technical assistance,are urged as soon as possible and to the extent their mandates and resources allowto allocate assured and increased funds to recipient countries, institutions andNG0s, as appropriate, for the preparation and implementation of national plansof action.

The governing bodies of FAO and WHO and other relevant internationalorganizations are requested to give specific consideration during 1993 todetermining ways and means of strengthening their capabilities towardsimplementing this World Declaration and Plan of Action. FAO and WHO arerequested to consider the inclusion of periodic reports on the overall follow-up ofthe ICN on the agenda of the regular FAO regional conferences and WHOregional committee meetings.

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UN organizations and other concerned parties are requested to prepare anddisseminate information for the public on the World Declaration and Plan ofAction.

In conclusion, the ICN should be viewed as a milestone in the continuingprocess to eliminate hunger and malnutrition, especially in the developingcountries, and at the same time to prevent an increase in the incidence of diet-related communicable and non-communicable diseases. The ICN preparatoryprocess began at the national and regional levels and, to be effective, its follow-upmust now be firmly anchored in national and regional commitment and efforts toprotect and promote the nutritional well-being of all.

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ANNEX I

NUTRITION GOALS OF THEFOURTH UNITED NATIONS DEVELOPMENT DECADE

Member States must give effect to agreements already reached to make allefforts to meet four goals during the decade:

To eliminate starvation and death caused by famine;To reduce malnutrition and mortality among children substantially;To reduce chronic hunger tangibly;To eliminate inajor nutritional diseases.

NUTRITION GOALS OF THE WORLD SUMMIT FOR CHILDREN(to be reached by the year 2000)

Reduction in severe, as well as moderate malnutrition amongunder-5 children by half of 1990 levels;Reduction of the rate of low birth weight (2.5 kg or less) to lessthan 10 percent;Reduction of iron deficiency anaemia in women by one-third of the1990 levels;Virtual elimination of iodine deficiency disorders;Virtual elimination of vitamin A deficiency and its consequences,including blindness;Empowerment of all women to breast-feed their childrenexclusively for four to six months and to continue breast-feeding,with complementary food, well into the second year;Growth promotion and its regular monitoring to be institutionalizedin all countries by the end of the 1990s;Dissemination of knowledge and supporting services to increasefood production to ensure household food security.

P T III - PARTICIPATING COUNTRIESORG ZATIONS

PARTICIPATING MEMBER STATES / ETATS MEMBRES PARTICIPANTS /ESTADOS MIEMBROS PARTICIPANTES

FRANCE° 'GABON4' GAMBIA4' GERMANY

GHANAGREECEGRENADA

* GUATEMALA"GUINEA'o GUINEA-BISSAU

GUYANA}um

° HONDURAS4' HUNGARY

ICELANDINDIAINDONESIAIRAN (ISLAMIC REP. OF)IRAQIRELANDISRAEL

4° ITALY° JAMAICA

JAPAN° JORDAN

KAZAKHSTANKENYAKOREA, REPUBLIC OFKUWAITLAOSLEBANON

* LESOTHOLIBERIALIBYALITHUANIALUXEMBOURGMADAGASCARMALAWIMALAYSIA

'I MALDIVESMALIMALTAMARSHALL ISLANDSMAURITANIAMAURMUSMEXICOMICRONESIAMONGOLIAMOROCCOMOZAMBIQUEMYANMARNAMIBIANEPAL

41 NETHERLANDSNEW ZEALAND

HOLY SEE"' List of countries which re ared an ICN Countr a er

Liste des a s a ant résenté un ex osé nationalLista de los aises ue repararon un documento ara la CIN

AFGHANISTANALBANIAALGERIAANGOLAARGENTINAARMENIA

O AUSTRALIAAUSTRIABAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBEI T7FBENIN

4' BHUTANBOLIVIABOTSWANABRASILBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECENTRAL AFRICAN REP.CHADCHILE

gi CHINA, PEOPLE'S REP. OFI' COLOMBIA

COMOROSCONGO

* COOK ISLANDSCOSTA RICACOTE DIVOIRECROATIACUBACYPRUSCZECHOSLOVAKIADEMOCRATIC PEOPLE'S

REPUBLIC OF KOREADENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPT

41 EL SALVADOREQUATORIAL GUINEAESTONIA

* ETHIOPIAEUROPEAN ECONOMIC

COMMUNITYFIJIFINLAND

NICARAGUANIGERNIGERIANORWAYOMANPAKISTANPANAMAPARAGUAYPERUPHILIPPINESPOLANDPORTUGAL

O QATARROMANIARUSSIAN FEDERATIONRWANDASAINT LUCIASAMOASAO TOME AND PRINCEPESAUDI ARABIASENEGALSEYCHELLESSIERRA LEONESLOVENIASOMALIASPAINSRI LANKASUDANSWAZILANDSWEDENSWITZERLANDSYRIATANZANIATHAILANDTOGOTOKELAUTUNISIATURKEY

0 UGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNTTED STATES OF

AMERICAURUGUAYVANUATUVENEZUELAVIET NAMYEMENZAIREZAMBIAZIMBABWE

Countries which did not participate at ICN br! submitted ICN Comaoprie5:10 A la ON mais avant présenté e. 'osé national / País

ero ue 'r ataron documentos

-2-

mismaaron en la CIN

Antigua and Barbuda Saint Vincent and the GranadinesBahamas Solomon IslandsKiribati SurinamePapua New Guinea TongaPuerto Rico Trinidad and TobagoSaint Kitts and Nevis

. a ers / Liste des a

- 3 -

LIBERATION MOVEMENTS

MOUVEMENTS DE LIBERATION

MOVIMIENTOS DE LIBERACION

Palestine Liberation Organization

African National Congress (S.A.)

UNITED NATIONS SPECIALIZED AGENCIES AND PROGRAMMES

NATIONS UNlES INSTUUTIONS SPECIALISEES ET PROGRAMMES

ORGANISMOS ESPECIALIZADOS Y PROGRAMAS DE LAS NACIONES UNIDAS

General Agreement on Tariffs and Trade(GATT)

International Fund for AgriculturalDevelopment (IFAD)

hnernational Labour Office (ILO)

United Nations Administrative Conunittee onCoordination/SubCommittee on Nutrition(ACC/SCN)

United Nations/Department of Economic andSocial Development (UNDESD)

United Nations Children's Fund (UNICEF)

United Nations Development Progranune(UNDP)

CAB International

Caribbean Conununity Secretariat (CARICOM)

Conunonwealth Secretariat

Communauté Economique des Etats de l'AfriqueCentrole (CEEAC)

INTER-GOVERNMENTAL ORGANIZATIONS

ORGANISATIONS INTERGOUVERNEMENTALES

United Nations Educational, Scientific andCultural Organization (Unesco)

United Nations Environment Programme(UNE!')

United Nations High Conunissioner for Refugees(UNHCR)

United Nation.s Population Fund (UNFPA)

United Nations University (UNU)

The World Bank

World Food Council (VVFC)

World Food Progranune (WFP)

ORGANIZACIONES INTERGUBERNAMENTALES

International Food Policy Research Institute(LFPRI)

League of Arab States

Office International des Epizooties

Organization of African -Unity (OAU)

Organization for Coordination and Cooperationin the Control of Major Endemic Diseases(OCCGE)

Academy for Education Development

Adventist Development and Relief AgencyInternational (ADRA)

Advocates for African Food Security

African Association for Literacy and AdultEducation (AALAE)

African Institute for Economic and SocialDevelopnient (INADES)

African Medical and Research Foundation(AMREF)

African Network for Integrated Deve/opment(RADI)

African Regional Organization forStandardization ( 'SO)

Associazione ItalianaDonne per lo Sviluppo (AIDOS)

American Public Health Association

The Arab Council for Childhood andDevelopment (ACCD)

Asian NGO Coalition for Agrarian Reformand Rural Development (ANGOC)

Asian Institute for Rural Development (AIRD)

Asociación Latinoamericana de Organizacionesde Promoción (ALOP)

- 4 -

NON-GOVERNMENTAL ORGANIZATIONS

ORGANISATIONS NON GOUVERNEMENTALES

ORGANIZACIONES NO GUBERNAMENTALES

Organization for Etonomic Co-operation andDevelopment (OECD)

South Pacific Conunission (SPC)

Assessoria e Servios a Projetos ern AgriculturaAlternativa (AS-PTA)

Association of African Women for Research andDevelopment (AAWORD)

Association de l'Industrie LaiMre des C.E.(ASSILEC)

Association Internationale "6S"

: International Conununity

BINA SWADAYA - Agency for Conummity Self-Relaiance Development

Bread for the World

The British Nutrition Foundation

CARE International

Caritas Internationalis

Catholic Diocese of Nakuru

Centre d'Analyse des Politiques de Santi

Centre International de l'Enfance

Centre to Prevent Childhood Malnutrition

Centro de Capacitación para el Desarrollo(CECADE)

Centro Mesoamericano de Estudios sobreTecnologia Apropiada (CEMAT)

Centro de Investigación en Alimentos

Centro Studi per l'Evoluzione Umana (C.E.U.)

Comitato Internazionale di Educazione per laPace (C.I.E.P.)

Comité Européen des Fabricants de Sucre(CEFS)

Comité des Fesmnes MarocainesForum Maglutbin pour l'Environnement et leDéveloppement

The Conunonwealth Association for Mentaldicap and Developmental Disabilities

(CAMHADD)

Confederation of the Food and Drink Industriesof the EEC (CIAA)

Conseil Alimentari Mediterrania

Consortium of NGOs in Cameroon (COPAD)

Comité international pour le développement despeuples (CISP)

Council for Developme,nt, Environmental Studies& Conservation (MAlUDESCO)

EAAE

Environmental Development Action in the ThirdWorld (ENDA)

European Association for Animal Production(EAAP)

European Association of Non-GovermnentalOrganizations for Food Aid and Emergency Aid(EuronAid)

EUROSTEP

Fanta Macalou

Federación de mujeres de carrera jurídica(IFWC)

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Centro Feminista de Información y Acción Fédération Européenne des Banques(CEFEMINA) Alimentaires

Centro Internazionale Cooperazione Federation of Hellenic Food Industriesallo Svilup (CICS) (S.E.V.T.)

ération Internationale des Vins etSpiritueux (FIVS)

FOCSIV

Fomento de la Vida (FOVIDA)

Food Aid Management

Food First Information and Action Network(FIAN)

Fonun Maghrébin pour l'Environnement et leDéveloppement

Fundación Vivir Mejor

GERM

Heifer Project Internafional

Helen Keller International I 11

The Hunger Project

Indian Association for Advancement of Science(I.A.A.S.)

Industry Council for Development (ICD)

Instant Haltien de l'Enfance

Inter-African Conunittee on TraditionalPractices Affecting the Health of Womenand Children (IAC)

International Alliance of Women (IAW)

International Association of AgriculturalEconomists (IAAE)

International Association of Educators forWorld Peace (IAE'WP)

International Baby Food Action Network(IBFAN)

International Catholic Rural Association (ICRA)

International Cham of Commerce (ICC)

International Confederation of Midwives(AIORCE)

International Confederation of Free TradeUnions (ICFIU)

International Co-operative Alliance (ICA)

International Council for Control of IodineDeficiency Disorders (ICCIDD)

International Council of Nurses

International Council of Voluntary Agencies(ICVA)

International Council of Women (ICW)

International Dairy Federation (IDF)

International Federation of AgriculturalProducers (IFAP)

International Federation of Clinical Chemistry(IFFC)

International Federation of GroceryManufacturers Associations (IFGMA)

International Federation for Home Economics(IFHE)

International Federation of Red Cross & RedCrescent Societies

International Federation of University Women

International Federation of Women in LegalCareers (IFWLC)

International Fertilizer Industry Association(IFA)

International Geographical Union (IGU)

International Lactation Consultant Association(ELCA)

International Life Sciences Institute (ILSI)

International Moveznent ATD Fourth World

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International SocietyCardiology (ISFC)

International Society for the Study ofXenobiotics (ISSX)

International Special Dietary Food Industries(ISDI)

International Union of Family Organizations(Ul0F)

International Union of Food Science &Technology (IUFOST)

International Union of Nutritional Sciences(FUNS)

hiternational Union of ProfessionalAgricultural Er-onomists (IUPAC)

International Vegetarian Union

International Youth and Student Movement forthe United Nations (ISMUN)

Istituto per la Cooperazione Universitaria(ICU)

Jesuit Refugees Service

La Leche League International (LLLI)

La Liga de la Lactancia Materna

Lion.s Clubs International

Médecins Sans Frontares (MSF)

Medi v Women's International Association(MVVIA)

National Council for International Health(NCIH)

National Health Education Institute

Network for Women - Suriname

hzternational Organization of Consumers Unions(IOCU)

International Peace Research Association '

International Romani Union

11 d Federation of

Nurture/Centre to Prevent ChildhoodMalnutrition

Pan Pacific and South-East Asia Women'sAssociation hiternational (PPSEAWA)

Patronato del Servicio Nacional de Nutrición(P.S.N.N.)

Program for Appropriate Technology in Health(PATI)

Save the Children

Second Harvest National Network of Food Banks

Servicios Múltiples de Tecnologia Apropiada(SEMTA)

Society for International Development (SID)

SOLAGRAL

Terra Nuova

Union Internationale des Syndicats del'Agriculture et de l'Alimentation (UIS)

Union Nationale des Coopératives des Planteurset IVIaraichers du Mali (UNCPM).

Union Tunisienne de l'Agriculture et de la nche

Unitas

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ICN SECRETARIAT

SECRETARIAT CIN

SECRETARIADO CIN

USA Food Industries Trade Council

WCL

Wel!start

Women International League for Peace andFreedom (WILPF)

World Alliance for reastfeeding Action(WABA)

World Association of Girl Guides and GirlScouts (WAG GGS)

World Federation for Medical Health

World Federation of Trade Unions (WYTU)

World Federation of United Nations Associations(WFUNA)

World Hunger Program

World Organization of the Scout Movement

World Sustainable Agriculture Association(VVSAA)

World Union of Catholic Women'sOrgani2alions (WUCWO/UMOFC)

World Vision International

Worldview International Foundation

Food and Agriculture Organization of World Health Organization (WHO)the United Nations (FAO)